Myofascial Pain
Myofascial Pain Syndrome constitutes a large group of muscle disorders characterized by the presence of hypersensitive points that we call trigger points. They can involve one or more muscles and the muscle's connective tissue. This can cause a syndrome of pain, muscle spasm, tenderness, stiffness, limitation of motion of the muscle, or associated joint, weakness in the muscle, and occasionally autonomic nervous system dysfunction. Trigger points can cause pain at the site of muscle injury but they also cause referred pain or pain that is felt in another area distant to the injury.
This syndrome constitutes one of the most important problems in clinical practice. They are among the most frequent causes of severe disabling pain. Because of the peculiar symptoms associated with trigger points, they were not generally recognized until recently. Consequently, they were often misdiagnosed and treated as bursitis, arthritis, or pain syndromes affecting the organs in the chest or abdomen.
What Causes Trigger Points?
The most easily identified causes of Myofascial Pain Syndromes are:
- Trauma to the muscle structures
- Acute overload of muscles with repetitive use
- Maladaptive postures
- Other disease processes
- Stress
Present knowledge of the abnormalities at the level of the tissue is limited. However, physicians do know that these trigger points have reduced high-injury phosphates and glycogen concentrations. We also know that the trigger point is able to irritate pain nerves located in the muscle. This sends a relay message to the spinal cord and eventually to the brain.
A number of responses are possible. The most readily understood involves the reflex action of the muscle itself. Various muscles associated with trigger points become tense and begin to fatigue. There is decreased blood flow within and around the trigger point. This causes the release of painful substances such as bradykinin and prostaglandin as well as other substances that cause additional irritation of the pain nerves around the trigger point. This can cause more muscle spasms and loss of range of motion of that muscle and associated joint, thereby causing more pain and leading to the development of more trigger points. Thus, the cycle begins and rarely will resolve without treatment.
How Are Trigger Points Treated?
Trigger points are identified on the physical examination. Prior to treatment these trigger points are re-identified and marked. The skin is then cleaned so that the procedure is performed aseptically. A special thin hypodermic needle is used to inject a local anesthetic into the knot, causing mechanical breakup of the trigger point and giving immediate relief.
Immediately after injection therapy, a warm, moist heat pack is applied to the area to relieve temporary discomfort. The patient is then instructed in some light flexibility exercises to perform approximately every two hours of the day of the procedure.
With continuous treatment, usually six sessions on a weekly basis, the painful cycle is resolved, pain is reduced, and function is restored. Dr. Bender usually prescribes trigger point injections in conjunction with the proper physical therapy program. This typically allows for the quickest recovery possible.
